“Two babies, born 15 months apart to the same young woman overcoming opioid addiction. Two very different treatments. Sarah Sherbert’s first child was whisked away to a hospital special-care nursery for two weeks of treatment for withdrawal from doctor-prescribed methadone that her mother continued to use during her pregnancy. Nurses hesitated to let Sherbert hold the girl and hovered nervously when she visited to breast-feed.

Born just 15 months later and 30 miles away at a different South Carolina hospital, Sherbert’s second child was started on medicine even before he showed any withdrawal symptoms and she was allowed to keep him in her room to encourage breast-feeding and bonding. His hospital stay was just a week.

“It was like night and day,” Sherbert said.

The different approaches highlight a sobering fact: The surge has outpaced the science, and no one knows the best way to treat the opioid epidemic’s youngest patients.”

“Newborns suffering from opioid withdrawal might have shorter hospital stays and less need for medications if they stay in a room with their mother instead of being sent to intensive care, a research review suggests.

Researchers examined data from six previously published studies with a total of 549 babies. Compared to opioid-exposed newborns treated in neonatal intensive care units (NICUs), infants who “roomed-in” with their mothers were 63 percent less likely to receive drugs like morphine or methadone for withdrawal symptoms, the study found.

With rooming-in, these babies also tended to leave the hospital about ten days sooner than infants treated in the NICU, a difference that might be explained by fewer complications or better quality care.”

“Infants born with neonatal abstinence syndrome (NAS) had significantly smaller head circumference than infants with no fetal exposure to opioids, a researcher said here.

Mean head circumference was almost a full centimeter smaller in infants born with NAS compared to controls (33.04 cm versus 33.99 cm, respectively, P<0.001), reported Craig V. Towers, MD, of the University of Tennessee Medical Center in Knoxville.

At a presentation at the Society for Maternal-Fetal Medicine’s Annual Pregnancy Meeting, Towers said that there have only been a few retrospective studies examining the effect of NAS on head circumference, and very limited prospective data on the subject.”

This Clinical Guide provides comprehensive, national guidance for optimal management of pregnant and parenting women with opioid use disorder and their infants. The Clinical Guide helps healthcare professionals and patients determine the most clinically appropriate action for a particular situation and informs individualized treatment decisions.

“The federal government needs to take more steps to help states protect infants born affected by drugs such as opioids, the U.S. Government Accountability Office says in a new report released Wednesday.

State agencies remain confused about a federal law requiring them to report drug-affected infants to child protective services — not to punish mothers but to help families and ensure the child’s safety, the GAO says. Thirty-eight states said more guidance would be “extremely to very helpful,” according to the report.

The GAO report was sparked by a 2015 Reuters investigation showing a growing number of newborns diagnosed with drug-withdrawal syndrome from opioids. Thousands of infants were sent home from hospital without the “plan of safe care” required by a 2003 federal law, the news agency found.”

Objectives To assess the impact of in utero co-exposure to psychotropic medications and opioids on the incidence and severity of neonatal drug withdrawal.

Setting Nationwide sample of pregnancies in publicly insured women in the US, nested in the Medicaid Analytic eXtract (2000-10).

Participants201 275 pregnant women with public insurance who were exposed to opioids around the time of delivery and their liveborn infants.

Interventions In utero exposure to psychotropic medications, in particular antidepressants, atypical antipsychotics, benzodiazepines, gabapentin, and non-benzodiazepine hypnotics (Z drugs), with prescriptions filled within the same time window as prescriptions for opioids.

Main outcome measure Diagnosis of neonatal drug withdrawal in infants exposed in utero to opioids and psychotropic medications compared with opioids alone.

Results The absolute risk for neonatal drug withdrawal ranged from 1.0% in infants exposed in utero to prescription opioids alone to 11.4% for those exposed to opioids co-prescribed with gabapentin. Among neonates exposed in utero to prescription opioids, the relative risk adjusted for propensity score was 1.34 (95% confidence interval 1.22 to 1.47) with concomitant exposure to antidepressants, 1.49 (1.35 to 1.63) with benzodiazepines, 1.61 (1.26 to 2.06) with gabapentin, 1.20 (0.95 to 1.51) with antipsychotics, and 1.01 (0.88 to 1.15) with Z drugs. In utero exposure to two or more psychotropic medications along with opioids was associated with a twofold increased risk of withdrawal (2.05, 1.77 to 2.37). The severity of the withdrawal seemed increased in neonates exposed to both opioids and psychotropic medications compared with opioids alone.

Conclusions During pregnancy, the use of psychotropic medications in addition to prescription opioids is common, despite a lack of safety data. The current findings suggest that these drugs could further increase the risk and severity of neonatal drug withdrawal.

“Taking a combination of opioids (strong prescription painkillers) and psychotropic medications (widely used to treat mental health conditions such as anxiety and depression) during pregnancy is associated with a greater risk of drug withdrawal in newborns, finds a study in the BMJ.

A team of US researchers based at Brigham and Women’s Hospital and Harvard Medical School, set out to assess the impact of in utero exposure to both psychotropic medications and opioids on number of cases and severity of neonatal drug withdrawal.

After taking account of several factors that could have affected the results (known as confounders), the absolute risk for neonatal drug withdrawal was substantially higher among women exposed to opioids and psychotropic medications than among women exposed to opioids alone.”

“The American foster care system is in a state of crisis, strained by a massive influx of children since 2011 fueled by the opioid epidemic and general drug abuse.

Social services in almost every state across the country are experiencing increases in children needing foster care, and officials are nearing a breaking point. Officials report a roughly 45 percent spike in the number of foster children since 2011 in Maine, which had more than 1,800 kids in foster care in 2016. In North Dakota, the number of kids removed from parental custody to foster care jumped 27 percent since 2011, reports The Washington Post.

Officials from the U.S. Department of Health and Human Services said in 2015 that roughly 428,000 kids were in foster care, and note that number has likely experienced a significant increase due to skyrocketing drug abuse rates in 2016. Opioid dependence is also becoming more prevalent in newborn babies whose parents are addicts.”

“Among the troubling developments of the nation’s opioid crisis: a large number of babies born prenatally exposed to opioids.

On a recent reporting trip, we visited Trinity Hospital in Steubenville, Ohio, where according to the acting CEO, 1 in 5 babies are born with prenatal opioid exposure. Other hospitals report as many as 1 in 8 newborns exposed to opioids in the womb.

It led us to wonder what long-term consequences there might be for the babies, some of whom experience neonatal abstinence syndrome at birth.

Dr. Joshua Sharfstein, a pediatrician and professor at the Johns Hopkins Bloomberg School of Public Health, has written about the topic. He says while there’s no evidence of “huge, obvious differences” in children who were exposed to opioids in the womb, there is a lot of research showing that the social environment plays a critical role in determining a child’s future.”

“A new study published today by the scientific journal Addiction reveals that the incidence of neonatal abstinence syndrome – often caused by mothers using opioids during pregnancy – is increasing in the United States, and carries an enormous burden in terms of hospital days and costs. The number of US hospital admissions involving neonatal abstinence syndrome increased more than fourfold between the years 2003 and 2012. In 2012, neonatal abstinence syndrome cost nearly $316 million in the United States.”Read more at: https://www.eurekalert.org/pub_releases/2017-06/sfts-tco060717.php